May 15, 2012 Features

Whole Patient, Whole Team

Nathan, age 8, was severely shaken at 3 months and is being raised by his grandmother. He is quadriplegic, receives nutrition through a feeding tube, and has poor head control and impaired vision. Nathan's team of health care professionals is committed to working together to help him reach his maximum potential and to allow him to participate in the general education curriculum. The first step was to help Nathan communicate. His physical therapist (PT), occupational therapist (OT), and speech-language pathologist worked together—the OT identified a proximity switch, a device that will allow him to activate a communication device with his limited movement; the PT designed strategies to help him learn to turn his head to activate the switch; and the SLP, working with the special education teacher, identified a low-tech communication system, including the vocabulary and symbols used, that can be expanded as his abilities increase. A vision specialist suggested ways to help Nathan attend to the symbols, and Nathan's special education teacher provided ongoing training to help him learn to activate the switch and use his system.

Clearly, this scenario requires health care providers from different disciplines to work together to achieve the best possible outcome. Indeed, speech-language pathologists and audiologists are typically expected to enter the workforce prepared to work as part of an interprofessional team. In fact, ASHA's certification standards for both professions require skills in such collaboration.

But do communication sciences and disorders graduates have the skills they need for successful collaboration with other professionals? The fact is that formal training in this area has lagged dramatically behind practice expectations.

How can programs help students, for example, learn to recognize and respect the roles, responsibilities, and competence of other professions; work with others to assess, plan, provide, and review care for individual patients; tolerate differences, misunderstandings, and shortcomings in other professions; and participate appropriately in and facilitate interprofessional case conferences and team meetings? (For a full description of interprofessional skills, see the American Association of Colleges of Nursing website [PDF].)

One solution is interprofessional education experiences, in which students from two or more professions learn from and about each other to improve their ability to collaborate and provide quality care (Clark, 1993; D'Amour & Oandasan, 2005).

At the University of Kentucky's Division of Communication Sciences and Disorders, we developed a collaborative, interprofessional, and interinstitutional project that provides clinical experiences to familiarize students with other disciplines and to teach the teamwork skills necessary for practice.

The project brought together two University of Kentucky departments—communication sciences and disorders and physical therapy—as well as the Eastern Kentucky University occupational therapy program and a regional hospital. Three students—one from each discipline—worked together and with their professional counterparts at the hospital to learn about and practice professional collaboration.

Planning

We planned this project in two phases. In the six-month exploration and planning stage, the core work group—including representatives from all organizations and disciplines—met periodically to obtain administrative support; coordinate student schedules; establish the course description, objectives, and requirements; discuss teaching strategies; and plan evaluation and grading. In the four-month refinement and preparation phase, the planning group refined the objectives, planned a weekly schedule of interprofessional activities, prepared syllabi, finalized assignment and supervision details, and prepared the students.

Objectives and Learning Outcomes

Our planning group initially identified a set of project objectives and student learning outcomes based on interprofessional outcomes described in the literature (Barr, 1998; Interprofessional Education Collaborative Expert Panel, 2011; Oandasan & Reeves, 2005). We modified these objectives and outcomes to focus on evidence-based health care and on facility-specific interprofessional issues and experiences (see chart [PDF]).

Implementation and Outcomes

The three students received basic information on the terms and issues related to interprofessional education and practice. We then held an orientation session for the students and their long-term care facility supervisors, facilitated by a faculty member with expertise in interprofessional education. The orientation included information about the people and organizations involved, goals of the project, project syllabus, and required activities. The students participated in activities designed to generate discussion about their perceptions of the other disciplines.

We also discussed professional roles and scopes of practice, barriers and facilitators to interprofessional practice, and the climate of interprofessional practice at the facility.

During the four-week program, the students participated in the weekly interprofessional learning activities (see chart [PDF]). Through the entire experience, they investigated and supported excellence in patient care by finding evidence from professional literature; had weekly discussions as a team and with experienced clinicians; and observed or participated in aspects of care provided by all three of the disciplines.

  • Week 1 included follow-up to the orientation activities and observations of a patient evaluation conducted jointly by members an interprofessional team at the hospital.
  • In Week 2, students participated as a team to examine a patient in the long-term care unit, evaluate the findings, develop an interprofessional plan of care, and present the plan of care at a rehabilitation team meeting.
  • In Week 3, the students participated in a high school career fair that required them to work as a team and educate others about their roles on the health care team.
  • Week 4 was devoted to wrap-up and evaluation.

Each of the three students began the interprofessional experience with positive perceptions of his or her own discipline, and by the end of the project experienced an overall increase in positive perceptions of the other disciplines as measured by student feedback and responses on the Interdisciplinary Education Perception Scale (IEPS; McFadyen, Maclaren, & Webster, 2007). This scale was administered at the beginning and end of the experience.

Additionally, the students were able to practice interprofessional team skills, articulate their own scope of practice, learn the roles of other professions, discuss community resources, and communicate with other health care professionals.

Lessons and Challenges

  • Simplicity. We developed a project that could be incorporated into existing practicum requirements. During the four-week project, students were required to meet once a week, perform each required observation/activity one time, and complete one interprofessional assessment and care plan. Despite the project's limited scope and duration, it was sufficient to modify students' perceptions of interprofessional education and to provide opportunities for them to practice collaborative skills.
  • Scheduling. The involvement of multiple programs made student scheduling more challenging, resulting in the inclusion of students at different stages in their educational and clinical preparation. Evaluations by students and supervisors, however, indicated no difficulties with that situation.
  • Partners. The existence of a fully functioning interprofessional rehabilitation team at the hospital committed to both excellence in care and clinical teaching was a driving force behind the project's success. In particular, the long-standing relationships among the multiple partners made the conceptualization, planning, and implementation of the project manageable within the available academic, agency, and clinical resources. The core work group was key to organizing and maintaining momentum during the nine-month planning process.
  • Changing staff. Our project has been suspended for about 18 months because of staff changes and leaves of absence. This situation can be a particular challenge in projects, like ours, that are heavily dependent on a single supervisor in each discipline. We recommend including a second supervisor in each discipline to allow for unexpected changes.

Although this interprofessional education program has been suspended because of personnel issues at the hospital, student participants and project staff believe the time and effort were well spent in developing and piloting an interprofessional clinical experience. This model can be easily adapted to other medical and educational facilities. We are working with a local preschool to replicate the project with more students and additional disciplines.

Judith L. Page, PhD, CCC-SLP, is associate professor and former director of the Division of Communication Sciences and Disorders, University of Kentucky. At the time of this project, she was chair of the Department of Rehabilitation Sciences. Her primary research interests are communication intervention strategies for persons with severe disabilities and augmentative and alternative communication systems. Contact her at judith.page@uky.edu.

Donna S. Morris, MA, CCC-SLP, is associate professor and clinical coordinator in the Division of Communication Sciences and Disorders, University of Kentucky. Her research interests focus on augmentative and alternative communication and pediatric oral-motor and feeding. Contact her at dsmorr0@uky.edu.

cite as: Page, J. L.  & Morris, D. S. (2012, May 15). Whole Patient, Whole Team. The ASHA Leader.

Interprofessional Education Resources



Why Interprofessional Education Matters

In interprofessional education (IPE), two or more professions learn about, from, and with each other to improve health outcomes for patients. The World Health Organization (WHO) promotes IPE and collaborative practice, as does ASHA.

ASHA supports and facilitates member engagement in IPE in academic programs (as demonstrated in the University of Kentucky program), clinical service, clinical research, and professional development. Making collaborative learning a part of classrooms and on-campus clinical environments equips clinicians to help improve the functional outcomes of those who receive rehabilitative services for communication disorders.

WHO also supports the role of global health organizations in IPE, which are increasingly influencing health policy. In accordance with these WHO priorities, the ASHA Board of Directors has developed the following IPE-related association action items:

  • Develop a white paper describing the role and involvement of audiologists and speech-language pathologists in IPE.
  • Facilitate a survey of needs regarding competency and plan educational offerings based on the results.
  • Collaborate with the Council on Academic Programs in Communication Sciences and Disorders on IPE for academic programs.
  • Consider an IPE track at the ASHA convention, and encourage participation from other disciplines.
  • Develop a long-range plan that includes IPE in academic preparation, clinical practice, and continuing education.
  • Consider IPE as a topic of discussion at ASHA researcher-academic town meetings.
  • Pursue funding to develop materials and resources.
  • Work with other health care organizations such as the American Occupational Therapy Association and the American Physical Therapy Association, and engage with other organizations representing professions that have participated in IPE (e.g., nursing, dentistry, pharmacy, and medicine).

Lemmietta McNeilly, PhD, CCC-SLP
ASHA Chief Staff Officer for Speech-Language Pathology



References

Barr, H. (1998). Competent to collaborate: Towards a competency-based model for interprofessional education. Journal of Interprofessional Care, 12, 181–187.

Clark, P. G. (1993), A typology of interdisciplinary education in gerontology and geriatrics: Are we really doing what we say we are? Journal of Interprofessional Care, 7(3), 217–227.

D'Amour, D., & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, 19, 8–20.

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative. Retrieved March 15, 2012, from www.aacn.nche.edu/education-resources/IPECReport.pdf [PDF].

McFadyen, A. K., Maclaren, W. M., & Webster, V. S. (2007).The Interprofessional Education Perception Scale (IEPS): An alternative remodeled sub-scale structure and its reliability. Journal of Interprofessional Care, 21, 433–443.

Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator, and the learning context. Journal of Interprofessional Care, 19, 21–38.



  

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